title: Predictors of survival and neurologic outcomes in children with traumatic out-of-hospital cardiac arrest during the early postresuscitative period.
abstract: BACKGROUND
  The outcome of children with traumatic out-of-hospital cardiac arrest (OHCA) is poor, and the information regarding survival in the postresuscitative period is limited. The aim of this study was to determine the clinical features during the early postresuscitative period that may predict survival or neurologic outcomes in children with traumatic OHCA.
  
  
  METHODS
  Information on 362 children (<19 years) who presented to the emergency departments of three medical centers and experienced traumatic OHCA during the study period (January 2003 to December 2010) were retrospectively included. The postresuscitative clinical features during the early postresuscitative period, defined as the first hour after achieving sustained return of spontaneous circulation, which correlated with survival and neurologic outcomes were analyzed.
  
  
  RESULTS
  Among 152 children (42%) who achieved sustained return of spontaneous circulation, 34 (9.4%) survived to discharge, and 11 (3%) had good neurologic outcomes (Pediatric Cerebral Performance Category Scale, 1 or 2). Early postresuscitative clinical features, which reflected initial cardiac output and end-organ perfusion, can predict the chance of survival. Such features included the following: high or normal blood pressure, normal heart rate, sinus rhythm, urine output of more than 1 mL/kg per hour, and noncyanotic skin color (all p < 0.05). Initial Glasgow Coma Scale (GCS) score of greater than 7 predicted a good neurologic outcome in survivors (p = 0.008).
  
  
  CONCLUSIONS
  Predictors of survival were high or normal blood pressure, normal heart rate, sinus rhythm, urine output of more than 1 mL/kg per hour, and noncyanotic skin color. Most importantly, initial GCS score of greater than 7 predicted a good neurologic outcome in survivors.
  
  
  METHODS
  Prognostic study, level III.
authors.affiliation: From the Department of Emergency Medicine (Y.-R.L., M.-C.Y., C.-C.C., C.-F.C.), Changhua Christian Hospital, Changhua; Department of Pediatrics (H.-P.W.), Buddhist Tzu Chi General Hospital, Taichung Branch; and School of Medicine (Y.-R.L., C.-C.C.), Chung Shan Medical University, Taichung; Department of Biological Science and Technology (Y.-R.L., W.-L.C., T.-H. T.), National Chiao Tung University, Hsinchu; Department of Pathology (T.-H. T.), Taichung Hospital, Department of Health, Executive Yuan, Taichung, and Department of Emergency Medicine (K.-H.W., C.-J.L.), Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yan-Ren
authors.initials: YR
authors.lastname: Lin
authors.forename: Han-Ping
authors.initials: HP
authors.lastname: Wu
authors.forename: Wen-Liang
authors.initials: WL
authors.lastname: Chen
authors.forename: Kuan-Han
authors.initials: KH
authors.lastname: Wu
authors.forename: Tsung-Han
authors.initials: TH
authors.lastname: Teng
authors.forename: Mei-Chueh
authors.initials: MC
authors.lastname: Yang
authors.forename: Chu-Chung
authors.initials: CC
authors.lastname: Chou
authors.forename: Chin-Fu
authors.initials: CF
authors.lastname: Chang
authors.forename: Chao-Jui
authors.initials: CJ
authors.lastname: Li
mesh_terms: D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007223:Infant; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D012151:Resuscitation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014563:Urodynamics / Q000502:physiology; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D055815:Young Adult